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Popular Medications No Longer Recommended for Chronic Pain

New guidelines say opioids like codeine are safer for patients over 75.

“I would be in a wheelchair without this medication,” Johnson says. “I use them very responsibly. I baby-sit my granddaughters, I drive my car. If you saw me, you’d never know I was on them.”

Johnson also uses Celebrex, a prescription NSAID, but only occasionally when her arthritis flares up. Anderson requires her to keep track of how often she takes the NSAID, and he has advised her against taking it every day.

Common Sense Solutions

For most people, physicians say, occasional NSAID use shouldn’t be a problem, as long as they follow dosage directions. There is no specific “safe” time period or dose—some people have stomach problems after a few days, others can tolerate NSAIDs for weeks—so physicians recommend consulting your doctor and watching for symptoms of possible complications, such as blood in your stool or an upset stomach. Aspirin is also an NSAID, but it’s unique because it doesn’t increase the risk of heart problems. The new guidelines are not meant to change doctor’s recommendation about taking baby aspirin for heart protection.

Although there is no absolute consensus, physicians agree that NSAID use should be watched carefully, especially among older patients with complicated medical histories.

In general, experts say, NSAIDs should be used periodically for arthritis flare-ups or acute problems. And patients on opioids need to start off on a low dose and slowly adjust it to find the dose that controls the pain but doesn’t impair daily function.

For people without liver problems, trying Tylenol first is recommended by most doctors. Trying nonpharmacological methods, from acupuncture to electrical nerve stimulation, might be an option as well.

Patients with severe pain may be willing to risk taking a medication that effectively treats their pain.

Research shows that NSAID use can cause people to have a significantly increased risk of gastrointestinal bleeding, especially among those over 75; some studies indicate that the risk of stomach bleeding may be as high as 15 times greater for someone on NSAIDs. But while the risk increases on NSAIDs, it still remains relatively low—in most studies, fewer than 5 percent of NSAID users had stomach bleeding. But that number increases as the number of risk factors—including age—increases. Similarly, some studies of the cardiovascular risk of NSAID use show a significant increase—even doubling the risk of heart attacks and other cardiovascular events. Once again, though, because the general risk of having a heart attack is relatively low, the increased risk may not be as scary as that statistic makes it sound.

“NSAIDs can be tolerated as long as they’re taken for comparatively short periods of time,” Anderson says. “[But] I’ve got patients that come in here and they’re taking 12 Aleve a day and they wonder why their stomach hurts.”

Experts on both sides of the issue agree that the best solution is for patients with chronic pain to discuss medications with their physician before using them regularly, even if they are over-the-counter drugs.

“The way I look at it, it comes down to the individual,” says Stephen Setter, an assoiate professor of pharmacology at Washington State University who specializes in geriatrics. “I think we’re making up ground for all the years that people took [NSAIDs] at any dose and any frequency. Now we know that is potentially detrimental, particularly as we age.”

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